Dental and medical office iMET to reduce teen tobacco, alcohol, and drug use

描述（由申请人提供）：本申请涉及广泛的挑战领域（05）比较有效性研究和特定主题（05-DE-102）牙科环境中烟草和药物依赖的治疗。该项目的目标是为青少年开发一个基于互联网/内联网的动机增强治疗（iMET）计划，目标是烟草，酒精和药物使用。这些物质与青春期死亡的主要原因和以后生活中的严重健康问题有关。我们的调查团队以前已经为针对酒精和药物使用的医疗办公室制定了筛查，短暂干预和转诊治疗（SBIRT）策略。我们基于CRAFFT屏幕创建了一个计算机程序（cSBIRT），青少年患者可以在候诊室自我管理，然后再去看初级保健提供者（PCP）。该计划立即显示青少年他/她的分数和风险水平，介绍有关物质使用的有害影响的科学信息和真实生活故事，并打印一份报告单，提示PCP建议青少年远离酒精和毒品。我们在最近的一项研究中发现，接受cSBIRT的青少年患者中有40%停止使用酒精/药物，这明显优于治疗作为药物（TAU）。然而，60%的人没有停止，需要额外的咨询，如MET。我们创造了我们的MET干预措施，专门适合青少年独特的发展需求。我们在最近的另一项研究中发现，MET在减少门诊药物滥用治疗人群中青少年的药物使用方面明显优于TAU。我们现在将调整这种经过验证的MET干预措施，并在前来接受常规医疗和牙科护理的青少年初级保健人群中进行测试，我们相信它会产生更大的效果。首先，我们必须调整MET，使其除了针对其他物质外，还针对烟草使用，并将其工具转换为计算机化格式。我们将设计iMET计划，使青少年可以自我管理几乎所有的，这使得它实际上用于忙碌繁忙的初级保健办公室。我们还将增加一个新功能，技术扩展器（TE），这是计算机生成的个性化电子邮件/短信，PCP在办公室访问后的几个月内发送给青少年患者，以延长iMET的效果。我们将在项目的第一年与青少年，家长和PCP进行重点小组讨论，并设计iMET系统以回应他们的意见和需求。我们将在我们的九个PCP办公室的研究网络中增加牙科实践，然后进行一项小型试点研究，比较iMET/TE与TAU。该试点的目的是评估新的iMET/TE系统在减少烟草、毒品和酒精使用方面的效果。我们将使用这些估计值和我们的初步研究经验，设计一项在更大的青少年人群中比较iMET/TE与TAU的未来研究，这可以通过统计学确定性证明iMET/TE系统是有效的。该项目的目的是通过一种新的基于互联网/内联网的动机增强疗法（iMET）干预措施，针对烟草、酒精和其他药物的使用，改善医疗机构中的青少年行为咨询服务。如果证明有效，我们将传播iMET的初级保健牙科和医疗办公室在美国的早期干预可以大大减少青少年药物使用及其相关的死亡率;防止其他严重后果;并大大减少相关的后期负担的人类痛苦和高昂的治疗费用。

DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (05) Comparative Effectiveness Research, and specific Topic (05-DE-102) Treatment of tobacco and drug dependence in dental settings. The goal of this project is to develop an Internet/Intranet-based Motivational Enhancement Therapy (iMET) program for adolescents that targets tobacco, alcohol, and drug use. These substances are associated with the leading causes of death during adolescence and serious health problems later in life. Our investigative team has previously developed screening, brief intervention, and referral to treatment (SBIRT) strategies for medical offices that target alcohol and drug use. We created a computer program (cSBIRT) based on the CRAFFT screen, which adolescent patients could self-administer in the waiting room before seeing the primary care provider (PCP). The program immediately shows the adolescent his/her score and level of risk, presents scientific information and true life stories about the harmful effects of substance use, and prints a Report sheet that prompts the PCP to advise the teen to stay away from alcohol and drugs. We found in a recent study that 40% of adolescent patients who received cSBIRT stopped using alcohol/drugs, which was significantly better than Treatment As Usual (TAU). However, 60% did not stop and need additional counseling, such as MET. We created our MET intervention to be specifically suited to the unique developmental needs of adolescents. We found in another recent study that MET was significantly better than TAU in reducing drug use among teens in an outpatient substance abuse treatment population. We will now adapt this proven MET intervention and test it in a primary care population of adolescents coming for routine medical and dental care, where we believe it will have an even greater effect. First, we must adapt MET so that it targets tobacco use in addition to other substances, and convert its tools to a computerized format. We will design the iMET program so that adolescents can self- administer nearly all of it, which makes it practical for use in busy PCP offices. We also will add a new feature, Technological Extenders (TEs), which are computer-generated personalized emails/text messages that PCPs send to teen patients during the months after the office visit to extend the effects of the iMET over time. We will hold focused group discussions with teens, parents, and PCPs during the first year of the project, and design the iMET system to respond to their opinions and needs. We will add dental practices to our research network of nine PCP offices, and then conduct a small pilot study comparing iMET/TE with TAU. The purpose of the pilot is to estimate the effect size of the new iMET/TE system in reducing tobacco, drug, and alcohol use. We will use these estimates and our pilot study experience to design a future study comparing iMET/TE to TAU in a much larger population of adolescents, which could prove with statistical certainty that the iMET/TE system is effective. The purpose of this project is to improve adolescent behavioral counseling services in healthcare settings with a new Internet/Intranet-based Motivational Enhancement Therapy (iMET) intervention that targets the use of tobacco, alcohol, and other drugs. If proven effective, we will disseminate iMET to primary care dental and medical offices across the U.S. Early intervention can substantially reduce teen substance use and its related mortality; prevent other serious consequences; and greatly decrease the associated later burdens of human suffering and high treatment costs.